Effects of adhesion barrier gel on functional outcomes of patients with lumbar disc herniation surgery; A systematic review and meta-analysis of clinical trials

Abstract

Failed Back Surgery Syndrome (FBSS) is persistent pain and disability following lumbar laminectomy which is associated with decreased quality of life and disability and has been reported in up to 40% of the patients undergoing lumbar laminectomy. Several approaches have been introduced to reduce the rate of the FBSS. Among these, applying anti-adhesive barrier gels have been studied with interest with controversial results. The aim of the current study was to determine the effects of anti-adhesive barrier gels on functional outcome and recurrence of patients undergoing lumbar disc surgery. We searched databases including EMBASE, PUBMED, Web of Science, Scopus, Cochrane Library, and scholar databases until November 2019. To assess the heterogeneity across included studies was used Cochran's Q and I-square (I 2 ) statistics. Standardized mean difference (SMD) and 95% CI between were used to estimate pooled effect sizes. Out of 4507, 10 clinical trials found to be appropriate for current meta-analysis. The pooled results of included clinical trials indicated that adhesion barrier gel significantly decreased leg pain (LP) (SMD ¼ À0.31; 95% CI, À0.60, À0.03; P ¼ 0.032; I 2 : 59.2%) among patients with lumbar disc herniation surgery. Back pain (BP) (SMD ¼ À0.03; 95% CI, À0.23, 0.16; P ¼ 0.734; I 2 : 40.2%), and Oswestry disability index (ODI) (SMD ¼ À0.11; 95% CI, À0.27, 0.05; P ¼ 0.178; I 2 : 0.0%), were not significantly affected following adhesion barrier gel application. Application of adhesion barrier gel in single level lumbar disc surgery is associated with deceased leg pain. However, its application does not affect the low back pain, disability and gate. Further, larger randomized clinical trials are required.

Failed back surgery syndrome—terminology, etiology, prevention, evaluation, and management: a narrative review

“…In addition, the intraoperative use of an adhesion barrier gel attenuates fibrosis and reduces inflammation and adhesion. A recent meta-analysis demonstrated that the application of an adhesion barrier gel in single-level lumbar disc surgery significantly decreased postoperative leg pain [ 35 ].…”

Interventional Therapy and Surgical Management of Lumbar Disc Herniation in Spine Surgery: A Narrative Review

“…1 Among those suffering from LBP, more than half are found to have lumbar intervertebral disc pathologies, such as radiculopathy, spinal stenosis, and herniations. 2 Lumbar disc herniations (LDH) are a common cause of LBP; affecting 2-3% of the general population and often requiring decompressive surgical interventions. 3 The lumbar spine is composed of five vertebral bodies and intervertebral discs with spinal nerves exiting below their corresponding vertebrae.…”

Case report: The promising application of dynamic functional connectivity analysis on an individual with failed back surgery syndrome

“…Disabling neuropathic pain usually persists or worsens with time and dramatically affects quality of life (Mondello et al, 2018). When other therapies have failed, treatment paradigms resort to spinal cord stimulation (SCS), which provides electric therapy through implanted electrodes for pain relief (Alizadeh and Sharifzadeh, 2021;Hosseini et al, 2021). In standard clinical practice, a subjective trial phase is carried out to determine patients who will benefit from SCS therapy before the permanent implantation of the device (North et al, 2020;De Andres et al, 2021).…”